Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical
psychotherapy that uses techniques derived from
behaviourism
Behaviorism is a systematic approach to understanding the behavior of humans and animals. It assumes that behavior is either a reflex evoked by the pairing of certain antecedent stimuli in the environment, or a consequence of that individual ...
and/or
cognitive psychology. It looks at specific, learned behaviours and how the environment, or other people's
mental states, influences those behaviours, and consists of techniques based on behaviorism’s theory of learning:
respondent or
operant conditioning. Behaviourists who practice these techniques are either
behaviour analysts or
cognitive-behavioural therapists. They tend to look for treatment outcomes that are objectively measurable. Behaviour therapy does not involve one specific method, but it has a wide range of techniques that can be used to treat a person's psychological problems.
[Antony, M.M., & Roemer, E. (2003). Behaviour therapy. In A.S. Gurman & S.B. Messer (Eds.), Essential psychotherapies (2nd ed., pp. 182-223). New York: Guilford.]
Behavioural psychotherapy is sometimes juxtaposed with
cognitive psychotherapy
Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one therapeutic approach within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Cogn ...
. While
cognitive behavioural therapy integrates aspects of both approaches, such as
cognitive restructuring
Cognitive restructuring (CR) is a psychotherapeutic process of learning to identify and dispute irrational or maladaptive thoughts known as cognitive distortions,Gladding, Samuel. Counseling: A Comprehensive Review. 6th. Columbus: Pearson Educati ...
,
positive reinforcement
In behavioral psychology, reinforcement is a consequence applied that will strengthen an organism's future behavior whenever that behavior is preceded by a specific antecedent stimulus. This strengthening effect may be measured as a higher fr ...
,
habituation
Habituation is a form of non-associative learning in which an innate (non-reinforced) response to a stimulus decreases after repeated or prolonged presentations of that stimulus. Responses that habituate include those that involve the intact org ...
(or
desensitisation),
counterconditioning Counterconditioning (also called stimulus substitution) is functional analytic principle that is part of behavior analysis, and involves the conditioning of an unwanted behavior or response to a stimulus into a wanted behavior or response by the as ...
, and
modelling.
Applied behaviour analysis
Applied behavior analysis (ABA), also called behavioral engineering, is a psychological intervention that applies empirical approaches based upon the principles of respondent and operant conditioning to change behavior of social significance.S ...
(ABA) is the application of behaviour analysis that focuses on functionally assessing how behaviour is influenced by the observable learning environment and how to change such behaviour through
contingency management
Contingency management (CM) is the application of the three-term contingency (or operant conditioning), which uses stimulus control and consequences to change behavior. CM originally derived from the science of applied behavior analysis (ABA), bu ...
or
exposure therapies, which are used throughout
clinical behaviour analysis therapies or other interventions based on the same learning principles.
Cognitive-behavioural therapy views cognition and emotions as preceding overt behaviour and implements treatment plans in psychotherapy to lessen the issue by managing competing thoughts and emotions, often in conjunction with behavioural learning principles.
A 2013 Cochrane review comparing behaviour therapies to psychological therapies found them to be equally effective, although at the time the evidence base that evaluates the benefits and harms of behaviour therapies was weak.
History
Precursors of certain fundamental aspects of behaviour therapy have been identified in various ancient philosophical traditions, particularly
Stoicism.
For example,
Wolpe and
Lazarus wrote,
The first use of the term behaviour modification appears to have been by
Edward Thorndike in 1911. His article ''Provisional Laws of Acquired Behavior or Learning'' makes frequent use of the term "modifying behavior". Through early research in the 1940s and the 1950s the term was used by
Joseph Wolpe
Joseph Wolpe (20 April 1915 in Johannesburg, South Africa – 4 December 1997 in Los Angeles) was a South African psychiatrist and one of the most influential figures in behavior therapy.
Wolpe grew up in South Africa, attending Parktown Boys' ...
's research group.
The experimental tradition in clinical psychology used it to refer to psycho-therapeutic techniques derived from empirical research. It has since come to refer mainly to techniques for increasing adaptive behaviour through reinforcement and decreasing maladaptive behaviour through extinction or punishment (with emphasis on the former). Two related terms are behaviour therapy and
applied behaviour analysis
Applied behavior analysis (ABA), also called behavioral engineering, is a psychological intervention that applies empirical approaches based upon the principles of respondent and operant conditioning to change behavior of social significance.S ...
. Since techniques derived from behavioural psychology tend to be the most effective in altering behaviour, most practitioners consider behaviour modification along with behaviour therapy and applied behaviour analysis to be founded in
behaviourism
Behaviorism is a systematic approach to understanding the behavior of humans and animals. It assumes that behavior is either a reflex evoked by the pairing of certain antecedent stimuli in the environment, or a consequence of that individual ...
. While behaviour modification and applied behaviour analysis typically uses interventions based on the same behavioural principles, many behaviour modifiers who are not applied behaviour analysts tend to use packages of interventions and do not conduct functional assessments before intervening.
Possibly the first occurrence of the term "behavior therapy" was in a 1953 research project by
B.F. Skinner
Burrhus Frederic Skinner (March 20, 1904 – August 18, 1990) was an American psychologist, behaviorist, author, inventor, and social philosopher. He was a professor of psychology at Harvard University from 1958 until his retirement in 1974.
...
,
Ogden Lindsley,
Nathan Azrin
Nathan H. Azrin (November 26, 1930 – March 29, 2013) was a behavioral modification researcher, psychologist, and university professor. He taught at Southern Illinois University and was the research director of Anna State Hospital between ...
and
Harry C. Solomon.
The paper talked about operant conditioning and how it could be used to help improve the functioning of people who were diagnosed with chronic schizophrenia. Early pioneers in behaviour therapy include
Joseph Wolpe
Joseph Wolpe (20 April 1915 in Johannesburg, South Africa – 4 December 1997 in Los Angeles) was a South African psychiatrist and one of the most influential figures in behavior therapy.
Wolpe grew up in South Africa, attending Parktown Boys' ...
and
Hans Eysenck.
In general, behaviour therapy is seen as having three distinct points of origin: South Africa (Wolpe's group), The United States (Skinner), and the United Kingdom (Rachman and Eysenck). Each had its own distinct approach to viewing behaviour problems. Eysenck in particular viewed behaviour problems as an interplay between personality characteristics, environment, and behaviour. Skinner's group in the United States took more of an
operant conditioning focus. The operant focus created a functional approach to assessment and interventions focused on
contingency management
Contingency management (CM) is the application of the three-term contingency (or operant conditioning), which uses stimulus control and consequences to change behavior. CM originally derived from the science of applied behavior analysis (ABA), bu ...
such as the
token economy
A token economy is a system of contingency management based on the systematic reinforcement of target behavior. The reinforcers are symbols or tokens that can be exchanged for other reinforcers. A token economy is based on the principles of o ...
and
behavioural activation. Skinner's student
Ogden Lindsley is credited with forming a movement called
precision teaching, which developed a particular type of graphing program called the standard celeration chart to monitor the progress of clients. Skinner became interested in the individualising of programs for improved learning in those with or without disabilities and worked with
Fred S. Keller to develop
programmed instruction. Programmed instruction had some clinical success in
aphasia
Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in t ...
rehabilitation. Gerald Patterson used programme instruction to develop his parenting text for children with conduct problems. (see
Parent management training
Parent management training (PMT), also known as behavioral parent training (BPT) or simply parent training, is a family of treatment programs that aims to change parenting behaviors, teaching parents positive reinforcement methods for improving pre ...
.) With age,
respondent conditioning
Classical conditioning (also known as Pavlovian or respondent conditioning) is a behavioral procedure in which a biologically potent stimulus (e.g. food) is paired with a previously neutral stimulus (e.g. a triangle). It also refers to the learn ...
appears to slow but
operant conditioning remains relatively stable. While the concept had its share of advocates and critics in the west, its introduction in the Asian setting, particularly in India in the early 1970s and its grand success were testament to the famous Indian psychologist
H. Narayan Murthy
Hosur Narayan Murthy (H. N. Murthy) ( kn, ಎಚ್. ಎನ್. ಮೂರ್ತಿ; 1924–2011) was an Indian clinical psychologist, writer, philosopher, Sanskrit scholar and teacher who headed the department of clinical psychology at National ...
's enduring commitment to the principles of behavioural therapy and biofeedback.
While many behaviour therapists remain staunchly committed to the basic
operant
Operant conditioning, also called instrumental conditioning, is a learning process where behaviors are modified through the association of stimuli with reinforcement or punishment. In it, operants—behaviors that affect one's environment—are c ...
and respondent paradigm, in the second half of the 20th century, many therapists coupled behaviour therapy with the
cognitive therapy
Cognitive therapy (CT) is a type of psychotherapy developed by American psychiatrist Aaron T. Beck. CT is one therapeutic approach within the larger group of cognitive behavioral therapies (CBT) and was first expounded by Beck in the 1960s. Co ...
, of
Aaron Beck
Aaron Temkin Beck (July 18, 1921 – November 1, 2021) was an American psychiatrist who was a professor in the department of psychiatry at the University of Pennsylvania. ,
Albert Ellis
Albert Ellis (September 27, 1913 – July 24, 2007) was an American psychologist and psychotherapist who founded rational emotive behavior therapy (REBT). He held MA and PhD degrees in clinical psychology from Columbia University, and was certi ...
, and
Donald Meichenbaum to form
cognitive behaviour therapy
Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (su ...
. In some areas the cognitive component had an additive effect (for example, evidence suggests that cognitive interventions improve the result of social phobia treatment.) but in other areas it did not enhance the treatment, which led to the pursuit of third generation behaviour therapies. Third generation behaviour therapy uses basic principles of operant and respondent psychology but couples them with functional analysis and a
clinical formulation
A clinical formulation, also known as case formulation and problem formulation, is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of t ...
/case conceptualisation of verbal behaviour more inline with view of the behaviour analysts. Some research supports these therapies as being more effective in some cases than cognitive therapy, but overall the question is still in need of answers.
Theoretical basis
The behavioural approach to therapy assumes that behaviour that is associated with psychological problems develops through the same processes of learning that affects the development of other behaviours. Therefore, behaviourists see personality problems in the way that personality was developed. They do not look at behaviour disorders as something a person has, but consider that it reflects how learning has influenced certain people to behave in a certain way in certain situations.
Behaviour therapy is based upon the principles of
classical conditioning
Classical conditioning (also known as Pavlovian or respondent conditioning) is a behavioral procedure in which a biologically potent stimulus (e.g. food) is paired with a previously neutral stimulus (e.g. a triangle). It also refers to the learni ...
developed by
Ivan Pavlov
Ivan Petrovich Pavlov ( rus, Ива́н Петро́вич Па́влов, , p=ɪˈvan pʲɪˈtrovʲɪtɕ ˈpavləf, a=Ru-Ivan_Petrovich_Pavlov.ogg; 27 February 1936), was a Russian and Soviet experimental neurologist, psychologist and physio ...
and
operant conditioning developed by
B.F. Skinner
Burrhus Frederic Skinner (March 20, 1904 – August 18, 1990) was an American psychologist, behaviorist, author, inventor, and social philosopher. He was a professor of psychology at Harvard University from 1958 until his retirement in 1974.
...
. Classical conditioning happens when a neutral stimulus comes right before another stimulus that triggers a reflexive response. The idea is that if the neutral stimulus and whatever other stimulus that triggers a response is paired together often enough that the neutral stimulus will produce the reflexive response. Operant conditioning has to do with rewards and punishments and how they can either increase or decrease certain behaviours.
Contingency management
Contingency management (CM) is the application of the three-term contingency (or operant conditioning), which uses stimulus control and consequences to change behavior. CM originally derived from the science of applied behavior analysis (ABA), bu ...
programs are a direct product of research from
operant conditioning.
Current forms
Behavioural therapy based on operant and respondent principles has considerable evidence base to support its usage. This approach remains a vital area of
clinical psychology and is often termed
clinical behavior analysis Clinical Behavior Analysis is one of several ABA subspecialty fact sheets produced by the BACB in partnership with subject matter experts (SMEs).
Clinical behavior analysis (CBA; also called clinical behaviour analysis or third-generation behavior ...
. Behavioral psychotherapy has become increasingly contextual in recent years. Behavioral psychotherapy has developed greater interest in recent years in personality disorders as well as a greater focus on acceptance and complex case conceptualizations.
Functional analytic psychotherapy
One current form of behavioural psychotherapy is
functional analytic psychotherapy Functional analytic psychotherapy (FAP) is a psychotherapeutic approach based on clinical behavior analysis (CBA) that focuses on the therapeutic relationship as a means to maximize client change. Specifically, FAP suggests that in-session conting ...
. Functional analytic psychotherapy is a longer duration behaviour therapy.
Functional analytic therapy focuses on in-session use of reinforcement and is primarily a relationally-based therapy.
As with most of the behavioural psychotherapies, functional analytic psychotherapy is contextual in its origins and nature.
and draws heavily on
radical behaviourism and
functional contextualism Functional contextualism is a modern philosophy of science rooted in philosophical pragmatism and contextualism. It is most actively developed in behavioral science in general and the field of behavior analysis and contextual behavioral science ...
.
Functional analytic psychotherapy holds to a process model of research, which makes it unique compared to traditional behaviour therapy and
cognitive behavioural therapy.
Functional analytic psychotherapy has a strong research support. Recent functional analytic psychotherapy research efforts are focusing on management of aggressive inpatients.
Assessment
Behaviour therapists complete a functional analysis or a functional assessment that looks at four important areas: stimulus, organism, response and consequences.
[Nelson, R.O., & Hayes, S.C. (1986). The nature of behavioural assessment. In R.O. Nelson & S.C. Hayes (Eds.) Conceptual foundations of behavioural assessment (pp. 3-41). New York: Guilford.] The stimulus is the condition or environmental trigger that causes behaviour.
An organism involves the internal responses of a person, like physiological responses, emotions and cognition.
A response is the behaviour that a person exhibits and the consequences are the result of the behaviour. These four things are incorporated into an assessment done by the behaviour therapist.
Most behaviour therapists use objective assessment methods like structured interviews, objective psychological tests or different behavioural rating forms. These types of assessments are used so that the behaviour therapist can determine exactly what a client's problem may be and establish a baseline for any maladaptive responses that the client may have. By having this baseline, as therapy continues this same measure can be used to check a client's progress, which can help determine if the therapy is working. Behaviour therapists do not typically ask the why questions but tend to be more focused on the how, when, where and what questions. Tests such as the Rorschach inkblot test or personality tests like the MMPI (
Minnesota Multiphasic Personality Inventory
The Minnesota Multiphasic Personality Inventory (MMPI) is a standardized psychometric test of adult personality and psychopathology. Psychologists and other mental health professionals use various versions of the MMPI to help develop treatment ...
) are not commonly used for behavioural assessment because they are based on personality trait theory assuming that a person's answer to these methods can predict behaviour. Behaviour assessment is more focused on the observations of a persons behaviour in their natural environment.
Behavioural assessment specifically attempts to find out what the environmental and self-imposed variables are. These variables are the things that are allowing a person to maintain their maladaptive feelings, thoughts and behaviours. In a behavioural assessment "person variables" are also considered. These "person variables" come from a person's social learning history and they affect the way in which the environment affects that person's behaviour. An example of a person variable would be behavioural competence. Behavioural competence looks at whether a person has the appropriate skills and behaviours that are necessary when performing a specific response to a certain situation or stimuli.
When making a behavioural assessment the behaviour therapist wants to answer two questions: (1) what are the different factors (environmental or psychological) that are maintaining the maladaptive behaviour and (2) what type of behaviour therapy or technique that can help the individual improve most effectively. The first question involves looking at all aspects of a person, which can be summed up by the acronym BASIC ID. This acronym stands for behaviour, affective responses, sensory reactions, imagery, cognitive processes, interpersonal relationships and drug use.
Clinical applications
Behaviour therapy based its core interventions on functional analysis. Just a few of the many problems that behaviour therapy have functionally analyzed include intimacy in couples relationships, forgiveness in couples,
chronic pain, stress-related behaviour problems of being an adult child of a person with an alcohol use disorder, anorexia, chronic distress, substance abuse, depression, anxiety, insomnia and obesity.
Functional analysis has even been applied to problems that therapists commonly encounter like client resistance, partially engaged clients and involuntary clients. Applications to these problems have left clinicians with considerable tools for enhancing therapeutic effectiveness. One way to enhance therapeutic effectiveness is to use positive reinforcement or operant conditioning. Although behaviour therapy is based on the general learning model, it can be applied in a lot of different treatment packages that can be specifically developed to deal with problematic behaviours. Some of the more well known types of treatments are: Relaxation training,
systematic desensitization
Systematic desensitization, or graduated exposure therapy, is a behavior therapy developed by the psychiatrist Joseph Wolpe. It is used when a phobia or anxiety disorder is maintained by classical conditioning. It shares the same elements of both c ...
, virtual reality exposure,
exposure and response prevention
Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger (desensitization). Doing so is tho ...
techniques, social skills training, modelling, behavioural rehearsal and
homework
Homework is a set of tasks assigned to students by their teachers to be completed outside the classroom. Common homework assignments may include required reading, a writing or typing project, Exercise (mathematics), mathematical exercises to b ...
, and
aversion therapy
Aversion therapy is a form of psychological treatment in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus wit ...
and punishment.
Relaxation training involves clients learning to lower arousal to reduce their stress by tensing and releasing certain muscle groups throughout their body. Systematic desensitization is a treatment in which the client slowly substitutes a new learned response for a maladaptive response by moving up a
hierarchy
A hierarchy (from Greek: , from , 'president of sacred rites') is an arrangement of items (objects, names, values, categories, etc.) that are represented as being "above", "below", or "at the same level as" one another. Hierarchy is an important ...
of situations involving fear.
Systematic desensitization is based in part on counter conditioning. Counter conditioning is learning new ways to change one response for another and in the case of desensitization it is substituting that maladaptive behaviour for a more relaxing behaviour. Exposure and response prevention techniques (also known as
flooding
A flood is an overflow of water ( or rarely other fluids) that submerges land that is usually dry. In the sense of "flowing water", the word may also be applied to the inflow of the tide. Floods are an area of study of the discipline hydrolog ...
and response prevention) is the general technique in which a therapist exposes an individual to anxiety-provoking stimuli while keeping them from having any avoidance responses.
Virtual reality therapy provides realistic, computer-based simulations of troublesome situations. The modelling process involves a person being subjected to watching other individuals who demonstrate behaviour that is considered adaptive and that should be adopted by the client. This exposure involves not only the cues of the "model person" as well as the situations of a certain behaviour that way the relationship can be seen between the appropriateness of a certain behaviour and situation in which that behaviour occurs is demonstrated. With the behavioural rehearsal and homework treatment a client gets a desired behaviour during a therapy session and then they practice and record that behaviour between their sessions.
Aversion therapy
Aversion therapy is a form of psychological treatment in which the patient is exposed to a stimulus while simultaneously being subjected to some form of discomfort. This conditioning is intended to cause the patient to associate the stimulus wit ...
and punishment is a technique in which an aversive (painful or unpleasant) stimulus is used to decrease unwanted behaviours from occurring. It is concerned with two procedures: 1) the procedures are used to decrease the likelihood of the frequency of a certain behaviour and 2) procedures that will reduce the attractiveness of certain behaviours and the stimuli that elicit them. The punishment side of aversion therapy is when an aversive stimulus is presented at the same time that a negative stimulus and then they are stopped at the same time when a positive stimulus or response is presented. Examples of the type of negative stimulus or punishment that can be used is shock therapy treatments, aversive drug treatments as well as response cost contingent punishment which involves taking away a reward.
Applied behaviour analysis is using behavioural methods to modify certain behaviours that are seen as being important socially or personally. There are four main characteristics of applied behaviour analysis. First behaviour analysis is focused mainly on overt behaviours in an applied setting. Treatments are developed as a way to alter the relationship between those overt behaviours and their consequences.
[Agras, W. Stewart., Alan E. Kazdin, and G. Terence Wilson. Behavior Therapy: Toward an Applied Clinical Science. San Francisco: W.H. Freeman, 1979. Print.]
Another characteristic of applied behaviour analysis is how it (behaviour analysis) goes about evaluating treatment effects. The individual subject is where the focus of study is on, the investigation is centred on the one individual being treated. A third characteristic is that it focuses on what the environment does to cause significant behaviour changes. Finally the last characteristic of applied behaviour analysis is the use of those techniques that stem from operant and classical conditioning such as providing reinforcement, punishment,
stimulus control and any other learning principles that may apply.
Social skills training
A social skill is any competence facilitating interaction and communication with others where social rules and relations are created, communicated, and changed in verbal and nonverbal ways. The process of learning these skills is called social ...
teaches clients skills to access reinforcers and lessen life punishment.
Operant conditioning
Operant conditioning, also called instrumental conditioning, is a learning process where behaviors are modified through the association of stimuli with reinforcement or punishment. In it, operants—behaviors that affect one's environment—are c ...
procedures in
meta-analysis
A meta-analysis is a statistical analysis that combines the results of multiple scientific studies. Meta-analyses can be performed when there are multiple scientific studies addressing the same question, with each individual study reporting me ...
had the largest effect size for training social skills, followed by
modelling, coaching, and social cognitive techniques in that order. Social skills training has some empirical support particularly for
schizophrenia
Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
. However, with schizophrenia, behavioural programs have generally lost favour.
Some other techniques that have been used in behaviour therapy are contingency contracting, response costs, token economies, biofeedback, and using shaping and grading task assignments.
[Kramer, Geoffrey P., Douglas A. Bernstein, and Vicky Phares. "Behavioral and Cognitive-Behavioral Psychotherapies." Introduction to Clinical Psychology. 7th ed. Upper Saddle River, NJ: Pearson Prentice Hall, 2009. 269-300. Print.]
Shaping and graded task assignments are used when behaviour that needs to be learned is complex. The complex behaviours that need to be learned are broken down into simpler steps where the person can achieve small things gradually building up to the more complex behaviour. Each step approximates the eventual goal and helps the person to expand their activities in a gradual way. This behaviour is used when a person feels that something in their lives can not be changed and life's tasks appear to be overwhelming.
[Freeman, Arthur. "Treatment of Suicidal Behavior." Comprehensive Handbook of Cognitive Therapy. New York: Plenum, 1989. Pg. 341. Print.]
Another technique of behaviour therapy involves holding a client or patient accountable of their behaviours in an effort to change them. This is called a contingency contract, which is a formal written contract between two or more people that defines the specific expected behaviours that you wish to change and the rewards and punishments that go along with that behaviour.
In order for a contingency contract to be official it needs to have five elements. First it must state what each person will get if they successfully complete the desired behaviour. Secondly those people involved have to monitor the behaviours. Third, if the desired behaviour is not being performed in the way that was agreed upon in the contract the punishments that were defined in the contract must be done. Fourth if the persons involved are complying with the contract they must receive bonuses. The last element involves documenting the compliance and noncompliance while using this treatment in order to give the persons involved consistent feedback about the target behaviour and the provision of reinforcers.
[Stuart, Richard B., and Leroy A. Lott, Jr. "Behavior Contracting with Delinquents." Journal of Behavior Therapy and Experimental Psychiatry 3 (1972): 161-69. Print]
Token economies is a behaviour therapy technique where clients are reinforced with tokens that are considered a type of currency that can be used to purchase desired rewards, like being able to watch television or getting a snack that they want when they perform designated behaviours.
Token economies are mainly used in institutional and therapeutic settings. In order for a token economy to be effective there must be consistency in administering the program by the entire staff. Procedures must be clearly defined so that there is no confusion among the clients. Instead of looking for ways to punish the patients or to deny them of rewards, the staff has to reinforce the positive behaviours so that the clients will increase the occurrence of the desired behaviour. Over time the tokens need to be replaced with less tangible rewards such as compliments so that the client will be prepared when they leave the institution and won't expect to get something every time they perform a desired behaviour.
Closely related to token economies is a technique called response costs. This technique can either be used with or without token economies. Response costs is the punishment side of token economies where there is a loss of a reward or privilege after someone performs an undesirable behaviour. Like token economies this technique is used mainly in institutional and therapeutic settings.
Considerable policy implications have been inspired by behavioural views of various forms of psychopathology. One form of behaviour therapy,
habit reversal training
Habit reversal training (HRT) is a "multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders".
Behavioral disorders treated with HRT include tics, trichotillomania, nail biting, th ...
, has been found to be highly effective for treating tics.
In rehabilitation
Currently, there is a greater call for behavioural psychologists to be involved in rehabilitation efforts.
Treatment of mental disorders
Two large studies done by the Faculty of Health Sciences at Simon Fraser University
indicates that both behaviour therapy and cognitive-behavioural therapy (CBT) are equally effective for OCD. CBT has been shown to perform slightly better at treating co-occurring depression.
Considerable policy implications have been inspired by behavioural views of various forms of psychopathology. One form of behaviour therapy (
habit reversal training
Habit reversal training (HRT) is a "multicomponent behavioral treatment package originally developed to address a wide variety of repetitive behavior disorders".
Behavioral disorders treated with HRT include tics, trichotillomania, nail biting, th ...
) has been found to be highly effective for treating tics.
There has been a development towards combining techniques to treat psychiatric disorders. Cognitive interventions are used to enhance the effects of more established behavioural interventions based on operant and classical conditioning. An increased effort has also been placed to address the interpersonal context of behaviour.
Behaviour therapy can be applied to a number of mental disorders and in many cases is more effective for specific disorders as compared to others. Behaviour therapy techniques can be used to deal with any phobias that a person may have. Desensitization has also been applied to other issues such as dealing with anger, if a person has trouble sleeping and certain speech disorders. Desensitization does not occur over night, there is a process of treatment. Desensitization is done on a
hierarchy
A hierarchy (from Greek: , from , 'president of sacred rites') is an arrangement of items (objects, names, values, categories, etc.) that are represented as being "above", "below", or "at the same level as" one another. Hierarchy is an important ...
and happens over a number of sessions. The hierarchy goes from situations that make a person less anxious or nervous up to things that are considered to be extreme for the patient.
Modelling has been used in dealing with fears and phobias. Modelling has been used in the treatment of fear of snakes as well as a fear of water.
Aversive therapy techniques have been used to treat sexual deviations as well as alcohol use disorder.
Exposure and prevention procedure techniques can be used to treat people who have anxiety problems as well as any fears or phobias. These procedures have also been used to help people dealing with any anger issues as well as pathological grievers (people who have distressing thoughts about a deceased person).
Virtual reality therapy deals with fear of heights,
[Krijin, M., Emmelkamp, P.M.G., Olafsson, R.P., & Biemond, R. (2004). Virtual reality exposure therapy of anxiety disorders: A review. Clinical Psychology Review, 24, 259-281.] fear of flying, and a variety of other anxiety disorders.
[Klein, R.A. (1999). Treating fear of flying with virtual reality exposure therapy. In L. Vandercreek & T.L. Jackson (Eds.), Innovations in clinical practice: A sourcebook, (Vol. 17). Sarasota, Fl: Professional Resource Press.] VRT has also been applied to help people with substance abuse problems reduce their responsiveness to certain cues that trigger their need to use drugs.
Shaping and graded task assignments has been used in dealing with suicide and depressed or inhibited individuals. This is used when a patient feel hopeless and they have no way of changing their lives. This hopelessness involves how the person reacts and responds to someone else and certain situations and their perceived powerlessness to change that situation that adds to the hopelessness. For a person with suicidal ideation, it is important to start with small steps. Because that person may perceive everything as being a big step, the smaller you start the easier it will be for the person to master each step.
This technique has also been applied to people dealing with agoraphobia, or fear of being in public places or doing something embarrassing.
Contingency contracting has been used to deal with behaviour problems in delinquents and when dealing with on task behaviours in students.
Token economies are used in controlled environments and are found mostly in psychiatric hospitals. They can be used to help patients with different mental illnesses but it doesn't focus on the treatment of the mental illness but instead on the behavioural aspects of a patient.
[Lloyd, Kenneth E., and Warren K. Garlington. "Weekly Variations in Performance on a Token Economy Psychiatric Ward." Behaviour Research and Therapy 6.4 (1968): 407-10. Print.] The response cost technique has been used to address a variety of behaviours such as smoking, overeating, stuttering, and psychotic talk.
[Kazdin, Alan E. "Response Cost: The Removal of Conditioned Reinforcers for Therapeutic Change." Behavior Therapy 3.4 (1972): 533-46. Web.]
Treatment outcomes
Systematic desensitization has been shown to successfully treat phobias about heights, driving, insects as well as any anxiety that a person may have. Anxiety can include social anxiety, anxiety about public speaking as well as test anxiety. It has been shown that the use of systematic desensitization is an effective technique that can be applied to a number of problems that a person may have.
When using modelling procedures this technique is often compared to another behavioural therapy technique. When compared to desensitization, the modelling technique does appear to be less effective. However it is clear that the greater the interaction between the patient and the subject he is modelling the greater the effectiveness of the treatment.
While undergoing exposure therapy, a person typically needs five sessions to assess the treatment's effectiveness. After five sessions, exposure treatment has been shown to provide benefit to the patient. However, it is still recommended treatment continue beyond the initial five sessions.
Virtual reality therapy
Virtual reality therapy (VRT), also known as virtual reality immersion therapy (VRIT), simulation for therapy (SFT), virtual reality exposure therapy (VRET), and computerized CBT (CCBT), is the use of virtual reality technology for psychological o ...
(VRT) has shown to be effective for a fear of heights.
It has also been shown to help with the treatment of a variety of anxiety disorders.
Due to the costs associated with VRT in 2007, therapists were still awaiting results of controlled trials investigating VRT, to assess which applications demonstrate the best results.
For those with suicidal ideation, treatment depends on how severe the person's depression and sense of hopelessness is. If these things are severe, the person's response to completing small steps will not be of importance to them, because they don't consider the success an accomplishment.
Generally, in those without severe depression or fear, this technique has been successful, as completion of simpler activities builds their confidences and allows them to progress to more complex situations.
Contingency contracts have been seen to be effective in changing any undesired behaviours of individuals. It has been seen to be effective in treating behaviour problems in delinquents regardless of the specific characteristics of the contract.
Token economies have been shown to be effective when treating patients in psychiatric wards who had chronic schizophrenia. The results showed that the contingent tokens were controlling the behaviour of the patients.
Response costs has been shown to work in suppressing a variety of behaviours such as smoking, overeating or stuttering with a diverse group of clinical populations ranging from sociopaths to school children. These behaviours that have been suppressed using this technique often do not recover when the punishment contingency is withdrawn. Also undesirable side effects that are usually seen with punishment are not typically found when using the response cost technique.
"Third generation"
Since the 1980s, a series of new behavioral therapies have been developed. These have been later labeled by
Steven C. Hayes as "the third-generation" of behavioural therapy.
Under this classification, the first generation of behavioural therapy is that independently developed in the 1950s by
Joseph Wolpe
Joseph Wolpe (20 April 1915 in Johannesburg, South Africa – 4 December 1997 in Los Angeles) was a South African psychiatrist and one of the most influential figures in behavior therapy.
Wolpe grew up in South Africa, attending Parktown Boys' ...
,
Ogden Lindsley and
Hans Eysenck, while the second generation is the cognitive therapy developed by
Aaron Beck
Aaron Temkin Beck (July 18, 1921 – November 1, 2021) was an American psychiatrist who was a professor in the department of psychiatry at the University of Pennsylvania. in the 1970s.
Other authors object to the term "third generation" or "third wave" and incorporate many of the "third wave" therapeutic techniques under the general umbrella term of modern cognitive behavioural therapies.
This "third wave" of behavioural therapy has sometimes been called clinical behaviour analysis because it has been claimed that it represents a movement away from cognitivism and back toward
radical behaviourism and other forms of
behaviourism
Behaviorism is a systematic approach to understanding the behavior of humans and animals. It assumes that behavior is either a reflex evoked by the pairing of certain antecedent stimuli in the environment, or a consequence of that individual ...
, in particular functional analysis and behavioural models of
verbal behaviour.
This area includes
acceptance and commitment therapy
Acceptance and commitment therapy (ACT, typically pronounced as the word "act") is a form of psychotherapy, as well as a branch of clinical behavior analysis. It is an empirically based psychological intervention that uses acceptance and mindfu ...
(ACT), cognitive behavioural analysis system of psychotherapy (CBASP) (McCullough, 2000),
behavioural activation (BA),
dialectical behavioural therapy,
functional analytic psychotherapy Functional analytic psychotherapy (FAP) is a psychotherapeutic approach based on clinical behavior analysis (CBA) that focuses on the therapeutic relationship as a means to maximize client change. Specifically, FAP suggests that in-session conting ...
(FAP),
integrative behavioural couples therapy,
metacognitive therapy
Metacognitive therapy (MCT) is a psychotherapy focused on modifying metacognitive beliefs that perpetuate states of worry, rumination and attention fixation. It was created by Adrian Wells based on an information processing model by Wells and Ge ...
and
metacognitive training
Metacognitive training, (MCT), is an approach for treating the symptoms of psychosis in schizophrenia, especially delusions, which has been adapted for other disorders such as depression, obsessive-compulsive disorder and borderline over the ye ...
. These approaches are squarely within the
applied behaviour analysis
Applied behavior analysis (ABA), also called behavioral engineering, is a psychological intervention that applies empirical approaches based upon the principles of respondent and operant conditioning to change behavior of social significance.S ...
tradition of behaviour therapy.
Acceptance and Commitment Therapy (ACT) may be the most well-researched of all the third-generation behaviour therapy models. It is based on
relational frame theory
Relational frame theory (RFT) is a psychological theory of human language, cognition, and behaviour. It was developed originally by Steven C. Hayes of University of Nevada, Reno and has been extended in research, notably by Dermot Barnes-Holmes ...
. As of March 2022, there are over 900 randomized trials of Acceptance and Commitment Therapy
and 60 mediational studies of the ACT literature.
ACT has been included in over 275 meta-analyses and systematic reviews.
As the result of multiple randomized trials of ACT by the World Health Organization, WHO now distribute ACT-based self-help for "anyone who experiences stress, wherever they live, and whatever their circumstances."
As of March 2022, a number of different organizations have stated that Acceptance and Commitment Therapy is empirically supported in certain areas or as a whole according to their standards. These include: American Psychological Association, Society of Clinical Psychology (Div. 12), The World Health Organization, The United Kingdom National Institute for Health and Care Excellence (NICE), Australian Psychological Society, Netherlands Institute of Psychologists: Sections of Neuropsychology and Rehabilitation, Sweden Association of Physiotherapists, SAMHSA's National Registry of Evidence-based Programs and Practices, California Evidence-Based Clearinghouse for Child Welfare, and the U.S. Veterans Affairs/DoD.
Functional analytic psychotherapy Functional analytic psychotherapy (FAP) is a psychotherapeutic approach based on clinical behavior analysis (CBA) that focuses on the therapeutic relationship as a means to maximize client change. Specifically, FAP suggests that in-session conting ...
is based on a functional analysis of the therapeutic relationship.
It places a greater emphasis on the therapeutic context and returns to the use of in-session reinforcement.
In general, 40 years of research supports the idea that in-session reinforcement of behaviour can lead to behavioural change.
Behavioural activation emerged from a component analysis of cognitive behaviour therapy. This research found no additive effect for the cognitive component. Behavioural activation is based on a matching model of reinforcement. A recent review of the research, supports the notion that the use of behavioural activation is clinically important for the treatment of depression.
Integrative behavioural couples therapy developed from dissatisfaction with traditional behavioural couples therapy. Integrative behavioural couples therapy looks to Skinner (1966) for the difference between contingency-shaped and rule-governed behaviour. It couples this analysis with a thorough functional assessment of the couple's relationship. Recent efforts have used radical behavioural concepts to interpret a number of clinical phenomena including forgiveness.
[Cordova, J.; Cautilli, J.D.; Simon, C. & Axelrod-sabag, R. (2006). Behavior Analysis of Forgiveness in Couples Therapy. ''IJBCT'', 2(2), 192–213.]
A review study published in 2008, concluded that at the time, third-generation behavioral psychotherapies did not meet the criteria for empirically supported treatments.
Organisations
Many organisations exist for behaviour therapists around the world. In the United States, the
American Psychological Association
The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...
's Division 25 is the division for
behaviour analysis. The
Association for Contextual Behavioral Science
The Association for Contextual Behavioral Science (ACBS) is a worldwide nonprofit professional membership organization associated with acceptance and commitment therapy (ACT), and relational frame theory (RFT) among other topics. The term "contex ...
is another professional organisation. ACBS is home to many clinicians with specific interest in third generation behaviour therapy. Doctoral-level behaviour analysts who are psychologists belong to
American Psychological Association
The American Psychological Association (APA) is the largest scientific and professional organization of psychologists in the United States, with over 133,000 members, including scientists, educators, clinicians, consultants, and students. It ha ...
's division 25 – Behaviour analysis. APA offers a diploma in behavioural psychology.
The
Association for Behavioral and Cognitive Therapies
The Association for Behavioral and Cognitive Therapies (ABCT) was founded in 1966. Its headquarters are in New York City and its membership includes researchers, psychologists, psychiatrists, physicians, social workers, marriage and family therap ...
(formerly the Association for the Advancement of Behavior Therapy) is for those with a more cognitive orientation. The ABCT also has an interest group in behaviour analysis, which focuses on clinical behaviour analysis. In addition, the Association for Behavioral an Cognitive Therapies has a special interest group on addictions.
Characteristics
By nature, behavioural therapies are empirical (data-driven), contextual (focused on the environment and context), functional (interested in the effect or consequence a behaviour ultimately has), probabilistic (viewing behaviour as statistically predictable),
monistic
Monism attributes oneness or singleness (Greek: μόνος) to a concept e.g., existence. Various kinds of monism can be distinguished:
* Priority monism states that all existing things go back to a source that is distinct from them; e.g., i ...
(rejecting mind–body
dualism and treating the person as a unit), and relational (analysing bidirectional interactions).
Behavioural therapy develops, adds and provides behavioural intervention strategies and programs for clients, and training to people who care to facilitate successful lives in various communities.
Training
Recent efforts in behavioural psychotherapy have focused on the supervision process. A key point of behavioural models of supervision is that the supervisory process parallels the behavioural psychotherapy provided.
[Callaghan, G.M. Functional Analytic Psychotherapy and Supervision. ''IJBCT'', 2(3), 416–31.]
See also
*
Behaviour management
*
Covert conditioning
Covert conditioning is an approach to mental health treatment that uses the principles of applied behavior analysis, or cognitive-behavior therapies (CBTs) to assist people in making improvements in their behavior or inner experience. The method r ...
*
Decoupling
*
Matching law
In operant conditioning, the matching law is a quantitative relationship that holds between the relative rates of response and the relative rates of reinforcement in concurrent schedules of reinforcement. For example, if two response alternatives A ...
*
Observational learning
Observational learning is learning that occurs through observing the behavior of others. It is a form of social learning which takes various forms, based on various processes. In humans, this form of learning seems to not need reinforcement to oc ...
*
Professional practice of behaviour analysis
References
Sources
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External links
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{{Authority control
Psychotherapies
Behaviorism
fr:Béhaviorisme